Diseases of the Colon & Rectum

, Volume 37, Issue 8, pp 747–753 | Cite as

Aggressive surgical management for advanced colorectal endometriosis

  • H. Randolph Bailey
  • Michael T. Ott
  • Paul Hartendorp
Original Contributions


PURPOSE: The aim of this study was to evaluate the results of aggressive surgical management in patients with advanced colorectal endometriosis. METHODS: The medical records of 130 women who had undergone aggressive surgical management of advanced colorectal endometriosis were reviewed. They were then interviewed a mean of 60 months following surgery and asked to rank relief of their symptoms. RESULTS: The most common symptoms before surgery were pelvic pain, dyspareunia, rectal pain, change in bowel habit, and cyclic rectal bleeding. Colorectal operations included low anterior resection, sigmoid resection, disc excision of the rectal wall, right colectomy, appendectomy, and small bowel resection. At follow-up symptom relief was high, ranging from 100 percent in cyclic bleeding to 91 percent for rectal pain. Mortality and clinical leakage rates were 0 percent, small bowel obstruction 3 percent, and abscess 1 percent. The crude pregnancy rate following surgery was 49 percent. CONCLUSIONS: These findings strongly support the use of aggressive surgical extirpation of all visible colorectal endometriosis for patients with advanced disease.

Key words

Endometriosis Colorectal endometriosis Intestinal resection Surgical management Fertility 


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  1. 1.
    Gray LA. Endometriosis. Clin Obstet Gynecol 1960;3:472–9.Google Scholar
  2. 2.
    Ranney B. Etiology, prevention, and inhibition of endometriosis of the colon. Clin Obstet Gynecol 1980;23:875–83.PubMedGoogle Scholar
  3. 3.
    Markham SM, Carpenter SE, Rock JA. Extrapelvic endometriosis. Obstet Gynecol Clin North Am 1989;16:193–219.PubMedGoogle Scholar
  4. 4.
    Bailey HR. Colorectal endometriosis. Perspect Colon Rectal Surg 1992;5:251–9.Google Scholar
  5. 5.
    Coronado C, Franklin RR, Lotze EC, Bailey HR, Valdes CT. Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 1990;53:411–6.PubMedGoogle Scholar
  6. 6.
    Levitt MD, Hodby KJ, van Merwyk AJ, Glancy RJ. Cyclical rectal bleeding in colorectal endometriosis. Aust N Z J Surg 1989;59:941–3.PubMedGoogle Scholar
  7. 7.
    Sampson JA. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 1927;14:422–69.Google Scholar
  8. 8.
    Stahl C, Grimes EM. Endometriosis of the small bowel. Case reports and review of the literature. Obstet Gynecol Surv 1987;42:131–6.PubMedCrossRefGoogle Scholar
  9. 9.
    MacAfee CH, Hardy Greer HL. Intestinal endometriosis. J Obstet Gynecol Br Emp 1960;67:539–55.Google Scholar
  10. 10.
    Farinon AM, Vadora E. Endometriosis of the colon and rectum: an indication for peroperative coloscopy. Endoscopy 1980;12:136–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Caccese WJ, McKinley MJ, Bronzo RL, Bronson R. Endoscopic confirmation of colonic endometriosis. Gastrointest Endosc 1984;30:191–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Sievert W, Sellin JH, Stringer CA. Pelvic endometriosis simulating colonic malignant neoplasm. Arch Intern Med 1989;149:935–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Meyers WC, Kelvin FM, Jones RS. Diagnosis and surgical treatment of colonic endometriosis. Arch Surg 1979;114:169–75.PubMedGoogle Scholar
  14. 14.
    Rambo WM, Johnson BL. Endometriosis mimics general surgical disease. Am Surg 1991;57:679–81.PubMedGoogle Scholar
  15. 15.
    Cattell RB. Endometriosis of the colon and rectum with intestinal obstruction. N Engl J Med 1937;217:9–18.CrossRefGoogle Scholar
  16. 16.
    McSwain B, Linn RJ, Haley RL Jr, Franklin RH. Endometriosis of the colon: report of 14 patients requiring partial colectomy. South Med J 1974;67:651–8.PubMedGoogle Scholar
  17. 17.
    Brooks JJ, Wheeler JE. Malignancy arising in extragonadal endometriosis: a case report and summary of the literature [abstract]. Cancer 1977;40:3065–73.PubMedGoogle Scholar
  18. 18.
    Amano S, Yamada W. Endometrial carcinoma arrising from endometriosis of the sigmoid colon [abstract]. Hum Pathol 1981;12:845–8.PubMedGoogle Scholar
  19. 19.
    Mostoufizadeh M, Scully RE. Malignant tumors arrising in endometriosis [abstract]. Clin Obstet Gynecol 1980;23:951–63.PubMedCrossRefGoogle Scholar
  20. 20.
    Lankerani MR, Aubrey RW, Reid JD. Endometriosis of the colon with mixed “germ cell” tumor [abstract]. Am J Clin Pathol 1982;78:555–9.PubMedGoogle Scholar
  21. 21.
    Lott JJ, Rubin RJ, Salvati EP, Salazar GH. Endometrioid carcinoma of the rectum arising in endometriosis: report of a case. Dis Colon Rectum 1978;21:56–60.PubMedGoogle Scholar
  22. 22.
    Rowland R, Langman JM. Endometriosis of the large bowel: a report of 11 cases. Pathology 1989;21:259–65.PubMedGoogle Scholar
  23. 23.
    Kratzer GL, Salvati EP. Collective review of endometriosis of the colon. Am J Surg 1955;90:866–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Weed JC, Ray JE. Endometriosis of the bowel. Obstet Gynecol 1987;69:727–30.PubMedGoogle Scholar
  25. 25.
    Prystowsky JB, Stryker SJ, Ujiki GT, Poticha SM. Gastrointestinal endometriosis. Incidence and indications for resection. Arch Surg 1988;123:855–8.PubMedGoogle Scholar
  26. 26.
    Collin GR, Russell JC. Endometriosis of the colon. Am Surg 1990;56:275–9.PubMedGoogle Scholar
  27. 27.
    Williams C. Endometriosis of the colon in elderly women. Ann Surg 1963;157:974–9.PubMedGoogle Scholar
  28. 28.
    Hendriksen E. Endometriosis. Am J Surg 1988;31:952–6.Google Scholar
  29. 29.
    Gray LA. Endometriosis of the bowel: role of bowel resection, superficial excision and oophorectomy in treatment. Ann Surg 1973;177:580–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Badawy SZ, Freedman L, Numann P, Bonaventura M, Kim S. Diagnosis and management of intestinal endometriosis. A report of five cases. J Reprod Med 1988;33:851–5.PubMedGoogle Scholar
  31. 31.
    Graham B, Mazier WP. Diagnosis and management of endometriosis of the colon and rectum. Dis Colon Rectum 1988;31:952–6.PubMedGoogle Scholar
  32. 32.
    Cuzzo Kriner MR. Intestinal endometriosis and its complications: case report and review. Mt Sinai J Med 1989;56:334–7.PubMedGoogle Scholar
  33. 33.
    Forsgren H, Lindhagen J, Melander S, Wagermark J. Colorectal endometriosis. Acta Chir Scand 1983; 149:431–5.PubMedGoogle Scholar
  34. 34.
    Max E, Sweeney WB, Bailey HR,et al. Results of 1,000 single-layer continuous polypropylene intestinal anastomoses. Am J Surg 1991;162:461–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Skakun GB, Reznick RK, Bailey HR, Smith KW, Max E. The single-layer continuous polypropylene colon anastomosis: a prospective assessment using water-soluble contrast enemas. Dis Colon Rectum 1988;31:163–8.PubMedGoogle Scholar
  36. 36.
    Candiani GB, Vercellini P, Fedele SB, Vendola N, Candiani M. Conservative surgical treatment for severe endometriosis in infertile women: are we making progress? Obstet Gynecol Surv 1991;48:490–8.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1994

Authors and Affiliations

  • H. Randolph Bailey
    • 1
  • Michael T. Ott
    • 1
  • Paul Hartendorp
    • 1
  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryThe University of Texas Health Science Center at HoustonHouston

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